中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (18): 2827-2832.doi: 10.3969/j.issn.2095-4344.3827

• 骨科植入物 orthopedic implant • 上一篇    下一篇

Sanders Ⅲ型跟骨骨折：后关节面排钉结合内外侧柱螺钉内固定的可靠性

伍  凯，林  健，黄寅骏，王秋根，黄建华，翁诗阳   

  1. 上海交通大学附属第一人民医院南院创伤骨科，上海市   201600
  • 收稿日期:2020-07-28 修回日期:2020-07-29 接受日期:2020-08-29 出版日期:2021-06-28 发布日期:2021-01-12
  • 通讯作者: 翁诗阳，博士，医师，上海交通大学附属第一人民医院南院创伤骨科，上海市 201600
  • 作者简介:伍凯，男，1975年生，2017年南京医科大学毕业，博士，医师，主要从事足踝创伤方面的研究。

Sanders type III calcaneal fractures: reliability of posterior facet screw fixation combined with lateral column screw fixation

Wu Kai, Lin Jian, Huang Yinjun, Wang Qiugen, Huang Jianhua, Weng Shiyang   

  1. Department of Orthopedic Trauma, South Branch of the First People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 201600, China
  • Received:2020-07-28 Revised:2020-07-29 Accepted:2020-08-29 Online:2021-06-28 Published:2021-01-12
  • Contact: Weng Shiyang, MD, Physician, Department of Orthopedic Trauma, South Branch of the First People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 201600, China
  • About author:Wu Kai, MD, Physician, Department of Orthopedic Trauma, South Branch of the First People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 201600, China

PDF

49

摘要：

文题释义：
跟骨骨折：跟骨骨折以足跟部剧烈疼痛、肿胀和淤斑明显、足跟不能着地行走及跟骨压痛为主要表现。此病成年人较多发生，常由高处坠下或挤压致伤。
Sanders分型：跟骨骨折中，Sanders分型基于CT冠状位扫描，在CT冠状位上选择跟骨后距关节面最宽处，由外向内分为3份，分别代表骨折线的位置。Sanders Ⅲ型骨折即三部分骨折。

背景：对于跟骨Sanders Ⅲ型骨折，经典“L型”大切口常会造成术后皮肤坏死等并发症。有学者研究表明，经跗骨窦切口使用微型钢板，术后切口问题显著降低，疗效相当，但仍缺乏生物力学方面的验证。
目的：在跟骨Sanders Ⅲ型骨折的尸体模型上进行生物力学实验，以验证后关节面排钉结合内外侧柱螺钉内固定的有效性及可靠性。
方法：在5具成人尸体下肢标本上，制备Sanders Ⅲ型关节内跟骨骨折模型。采用高柔韧型F3钢板系统排钉固定后关节面，另用2枚空心钉分别支撑内外侧柱。同时在跟骨前部骨块(骨块A)、后关节面内侧骨块(骨块M)、后关节面外侧骨块(骨块L)及跟骨后部骨块(骨块P)分别进行刚体标记。将各骨块之间的相对距离分别标记为：AM，AL，AP，ML，MP，LP。随后在生物力学测试平台上，进行800 N的循环负载实验和2 000 N的极限负载实验；同时利用Qualisys运动捕捉系统跟踪各骨块刚体间的位移，应用Qualisys Track Manager软件记录并分析数据。
结果与结论：①在800 N循环负载实验中，各刚体之间位移AM，AL，AP，ML，MP，LP的中位数分别为1.60，1.68，2.45，2.20，1.20，2.00 mm，均值分别为1.99，2.05，2.05，2.48，1.17，1.97 mm；②而在2 000 N的极限负载条件下，各刚体之间位移AM，AL，AP，ML，MP，LP的中位数分别为2.10，1.85，2.40，2.10，1.50，1.70 mm，均值分别为2.09，1.88，2.44，2.10，1.59，1.69 mm；③所有标本的内固定系统在2项实验中都承受住了所加载的负荷，并保持了完整性和牢靠性，无一例发生断钉和退钉或钢板折弯，仅1例发生1枚空心钉轻度折弯；④后关节面排钉结合内外侧柱螺钉的内固定效果和生物力学强度达到了设计的预想，是一种微创治疗Sanders Ⅲ型跟骨骨折的可靠而有效的方法。
https://orcid.org/0000-0002-8458-0000 (伍凯)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 跟骨骨折, Sanders Ⅲ型, 生物力学, 循环负载, 极限负载

Abstract: BACKGROUND: For Sanders type III calcaneal fractures, the classic “L-type” large incision often causes postoperative skin necrosis and other complications. Some scholars have shown that the use of mini plate through the tarsal sinus incision can significantly reduce the incision problems and achieve the same curative effect. However, there is still a lack of biomechanical verification.
OBJECTIVE: Biomechanical tests were carried out on Sanders III cadaveric model to verify the effectiveness and reliability of posterior facet screw fixation combined with lateral column screw fixation.
METHODS: Sanders III intra-articular calcaneal fracture models were established on five adult cadaveric lower limb specimens. The high flexible F3 plate system was used to fix the posterior articular surface, and two cannulated screws were used to support the inner and outer columns respectively. At the same time, the anterior calcaneal bone mass (block A), the medial posterior articular surface bone mass (bone block M), the lateral posterior articular surface bone mass (bone block L), and the posterior calcaneal bone block (bone block P) were labeled with rigid body. The relative distances between the bone fragments were marked as AM, AL, AP, ML, MP, LP. Then, 800 N cyclic load test and 2 000 N ultimate load test were carried out on the biomechanical test platform. Simultaneously, the displacement between the rigid bodies of each bone block was tracked by using the Qualisys motion capture system, and the data were recorded and analyzed by using the software of Qualisys track manager.
RESULTS AND CONCLUSION: (1) In 800 N cyclic load test, the median displacements of AM, AL, AP, ML, MP and LP were 1.60, 1.68, 2.45, 2.20, 1.20 and 2.00 mm, and the average values were 1.99, 2.05, 2.05, 2.48, 1.17 and 1.97 mm. (2) Under the limit load of 2 000 N, the median displacements of AM, AL, AP, ML, MP and LP were 2.10, 1.85, 2.40, 2.10, 1.50 and 1.70 mm, and the average values were 2.09, 1.88, 2.44, 2.10, 1.59 and 1.69 mm. (3) The internal fixation system of all specimens withstood the load and maintained its integrity and reliability in both tests. There was no broken nail, no screw withdrawal or plate bending. Only one hollow nail was slightly bent in one case. (4) The internal fixation effect and biomechanical strength of the posterior facet screw fixation combined with lateral column screw fixation meet the design expectations. It is a reliable and effective method to treat sanders III calcaneal fractures with minimally invasive treatment.

Key words: calcaneal fracture, sanders III, biomechanics, cyclic loading, ultimate loading

中图分类号: